PVD: Aortic. PAD Flashcards
Most common site for thoracic Ao aneurysm?
Desc thoracic Ao
What diameter Ao is considered a AAA?
> 3cm or 50% inc in size c/w prox segment
Timing of Ascending TAA repair
> 5.5cm for most patients
>4.5cm for bicuspid AV, Marfans or Ehlers-Danlos
Timing of descending TAA repair
> 6.5cm
Can you do endovascular repair for an ascending Ao aneurysm?
No
Surgical morbidity for descending TAA repair
Paraplegia
Is open surgery or endovascular preferred for AAA repair?
Endovascular
What is difference in mortality b/w endovascular or open AAA repair? Morbidity?
None
Lower morbidity with endovascular
Timing of repair of AAA
> 5.5cm
What to do with pt with AAA 4-5.4cm?
U/S or CT every 6-12 months
What to do for pt with AAA <4cm?
U/S every 2-3 yrs
When do you repair a AAA regardless of diameter?
sxs
Guidelines for management of AAA
4cm- U/S every 2-3 yrs
4-5.4cm- U/S or CT every 6-12months
5.5cm- repair
Any sxs = repair
USPSTF recs for AAA screening
Screen any man age 65-75 who ever smoked
No routine screening for women (even with family hx)
When can you screen a person for AAA if they have a first degree relative with AAA?
When it is a MAN 60 yrs old or older (not women)
When do you intervene on a lower ext aneurysm?
> 2cm
Where are lower ext aneurysms most commonly found?
Popliteal 80%
Iliac 20%
50% rule for lower ext. aneurysms
50% bilateral
50% assoc. w/ AAA (should screen)
50% asymptomatic
What to do if a pt has lower ext aneurysm?
Imaging of contralateral ext and AAA screen
If lesion >2cm, repair
If lesion <2cm, annual imaging
Which medication increases functional capacity in claudication?
Cilostazol
How to calculate ABI
Take ipsilateral Highest ankle pressure. Divide it by HIGHEST brachial pressure on EITHER side.
What is a normal ABI?
.91-1.3
What is an abnormal ABI?
< .9
ADA rec for screening diabetics for PAD
Do ABI in diabetics > 50 y/o, if normal, repeat in 5yr
What med can you use for an asymptomatic pt with PAD?
Aspirin
Class I recs for patients with PAD
ASA
Antihypertensives, DM, smoking cessation
High dose statins
Do you use DAPT for PAD?
No. Single therapy.
When do you use Plavix in PAD?
As alternate to ASA
What is the most high yield Rx for pt’s with PAD and intermittent claudication?
Home exercise
What is the blackboard warning for cilostazol
Do not give in CHF
What is the class of recommendation for prophylactic endovascular intervention on an asymptomatic pt with lower ext PAD?
III
When can you do intervention on PAD?
Sxs are LIFESTYLE limiting AND inadequate response to exercise and meds and favorable risk of procedure.
Can you put a stent in femoral, popliteal, tibial arteries?
No
If pt has CLI, which lesion should you fix first?
Inflow (Ao, femoral or iliac)
